The other day I was reading reports from one of the organisations that accepts donations of formula in Haiti. It was quite horrifying. Formula was being used because mothers were malnourished or sick instead of treating the mother and enabling her to breastfed. They also described how they would run out of formula and then have to make choices abotu which formula dependent babies would receive formula and which would not. There did not appear to be any realisation that they had unnecesarily created the dependency. There are very good reasons why aid orgs are supposed to buy any infant formula they need. They need to budget for providing all of the needs of all of the infants they are supporting for the first 6 months at least. Purchasing also ensures that they end up with what they need (not out of date, of the wrong type or labelling in the wrong language) AND that they are very careful about dispensing it. I'll paste in below some more info on the sort of support carers of artificially fed infants require from organisations providing formula....If you acquaintance is serious about helping artificially fed babies and insistent on providing donations she should also raise the considerable funds necessary to achieve what is required to aupport artificial feeding. Karleen Gribble Australia 1) A constant supply of breastmilk substitute The carers of infants in need of artificial feeding support must be provided with an assured, continuous and sufficient supply breastmilk substitutes (meeting Codex Alimentarius standards) for as long as the infants require them. That is, until breastmilk is available to the infant or the infant is at least six months of age. After six months, some other sort of milk and or animal food is required for non-breastfed children during the complementary feeding period (6-24 months) (Operational Guidance 6.4.3). Continuity of supply is vital because otherwise carers may use milk products which are unsuitable for infants, give sugar water and/or fruit juice between feeds, give fewer feeds per day or over-dilute breastmilk substitutes, to the detriment of the infant [1], [2]. For an infant to be artificially fed between birth and six months of age requires, approximately 20 kg of powdered breastmilk substitute[3]. Breastmilk substitutes should be labelled in the local language and preferably be unbranded (Operational Guidance 6.3.2). Distribution of breastmilk substitutes and supporting resources should be carried out to caregivers of targeted infants regularly (every week- two weeks). 2) Clean water and fuel to boil that water Water is needed for hand washing, for cleaning feeding implements and for reconstituting breastmilk substitutes. At least three litres of safe water a day must be provided for artificially fed infants in addition to any family water supplies. All water used in the preparation of breastmilk substitutes and the cleaning of feeding implements must be boiled (bottled water is not sterile[4]). It should be ensured that the carers of artificially fed infants have the resources to boil water and if they do not they should be provided. Such resources may be substantial, for example, a year’s worth of fuel amounts to 73kg of wood to boil the water using a wood fire[5]. 3) Containers and implements for storing water, preparing and feeding breastmilk substitutes Carers of infants needing breastmilk substitutes require sealable containers for storing water, pots in which water may be boiled, containers in which breastmilk substitutes may be reconstituted, measuring instruments and feeding cups (not bottles). If carers do not have these resources they need to be provided by the implementing agency. 4) A clean environment for preparing feeds and soap for cleaning Soap is necessary for hand washing and to assist in cleaning preparation and feeding containers. A clean feed preparation area is also necessary as is a clean storage area for powdered breastmilk substitutes. A plastic box may used to provide these environments, the lid acting as a preparation area while clean equipment and breastmilk substitute is stored inside. Drying cloths should not be provided because they are a breeding ground for bacteria, however equipment may air dry, disposable paper napkins used or equipment could be left in the water after boiling. 5) Education Carers require education on how to safely prepare and dispense artificial feeds. The aim of such education is to reduce the risk that artificial feeds expose infants to pathogens. Such education needs to start with a) how to store water, because it has been found that drinking water is often stored improperly at household level, resulting in contamination with E. Coli [6]. b) how to most safely reconstitute breastmilk substitutes, which is a complicated process, not only because powder and water must be accurately measured but because powdered breastmilk substitutes themselves can be contaminated with pathogens (i.e. infant formula is NOT sterile when in unopened sealed containers). Thus, in order to kill bacteria, powdered breastmilk substitutes should be prepared with water no cooler than 70°C[7]. This requires bringing water to a rolling boil for at least two minute, allowing it to cool to no less than 70°C (max 30 minutes after boiling) before adding it to the breastmilk substitute. Immediately after preparation the reconstituted breastmilk substitute should be quickly cooled to feeding temperature by holding container under running tap, or placing in container of cold water in order to minimise the risk of bacterial proliferation. c) how to accurately measure the breastmilk substitute and water in reconstitution and the dangers of over-diluting or over-concentrating breastmilk substitutes is also needed. d) how to clean preparation and feeding implements, including the need to disinfect via boiling. e) how to feed the baby via the use of a cup and the need to discard unused milk after feeds (since milk is an excellent medium for bacterial growth). Education should not be just in the form of providing verbal or written instructions but also one-on-one demonstrations and practical training (Operational Guidance 6 2.3, 6.2.4). The difficulty of providing education may be increased in environments where artificial feeding is uncommon and where carers are unable to read instructions. 6) Support The logistics of a caregiver making up fresh breastmilk substitutes using hot water every 3-4 hours and especially during the night are massive. Research supports the proposition that carers find following the recommended practices difficult [8],[9]. The challenges in the preparation and storage of artificial feeds, despite counseling and support, are illustrated in the following research from rural Uganda where mothers failed to follow the minimum guidelines for artificial feeding. Case study: In research from rural Uganda among HIV infected mothers (2008), excess mortality was found amongst infants of HIV positive mothers, who were artificially fed. One of the actions taken was additional support, targeted at mothers whose babies were established on artificial feeding. A household hygiene survey was conducted of these mothers (n=29) that found: -all mothers reported using soap and water to wash hands and utensils. However 59% (n=17) reported reusing feeding utensils without washing -despite a ban on using bottles to feed, 86.7% (n=25) of mothers were using them -17.2% (n=5) mothers stored left over feed -31.1% (n=9) reported difficulties maintaining clean utensils -65.5% (n=19) reported difficulty measuring formula -31.1% (n=9) reported difficulty in keeping utensils clean for night feeds -59% (n=17) delegated feeding to caretakers, 47.1% (n=7) to older children and the remaining to the father or a relative -79.3% (n=23) had a toilet but only 47.8% (n=11) had handwashing facilities at the toilet During emergencies the increased dangers of artificial feeding together with the additional pressures on a caregiver mean that it is vitally important to the safety of the infant that caregivers strictly follow the recommended practice. Carers therefore need continued support from the implementation agency to enable them to make artificial feeding as safe as possible. In circumstances where it is impossible to support carers (both in terms of physical and educational resources) to the extent that the risks of artificial feeding are reduced to an acceptable level to enable, on-site reconstitution and consumption of breastmilk substitutes (may be referred to as “wet” feeding) may be considered (Operational Guidance 6.2.5). Care should be taken that there is no stigma attached to the need to use breastmilk substitutes. 7. Monitoring and health care Artificially fed infants, especially in emergencies, are highly susceptible to illness and supporting artificial feeding must include regular monitoring of the growth and health of infants and access to health care. Their weight and health should be monitored each time breastmilk substitutes are provided to their carers (no less than twice a month) and they should receive any necessary medical support. 8. Ensure that carers are not given products that could be mistaken for a breastmilk substitute Sometimes other milk products such as whole milk powder, skim milk powder or condensed milk are distributed in emergency situations. Carers can easily mistake these products for a breastmilk substitute and feed them to their infants to the detriment of their health. All care should be taken to ensure that other milk products are not a part of general distributions. -------------------------------------------------------------------------------- ----- Original Message ----- From: "Jamelle Lyons" <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, February 09, 2009 11:18 AM Subject: Formula Donations to Haiti I need help, and I need to vent. A very nice woman on the 'Social Justice' commitee at church is co-ordinating a food and clothing drive to send items Haiti. Among the items that she requested donations for are the following: powdered milk, non-fat powdered milk, Similac with Iron. I *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome